Does the US discard too many transplantable kidneys?

Approximately 2,000 donated kidneys are discarded in the United States each year, despite a serious shortage of organs for transplantation. By studying transplant data from the United Network for Organ Sharing and from the French Organ Procurement Agency from 2004 to 2014, Olivier Aubert, MD, PhD, Alexandre Loupy, MD, PhD (Paris Translational Research Center for Organ Transplantation), and their colleagues compared kidney quality and outcomes between the United States and France.

During this period, 156,089 kidneys in the United States and 29,984 kidneys in France were procured for transplant. A much higher proportion of transplanted French kidneys were considered higher-risk organs (as measured by the kidney donor profile index, KDPI) compared with US organs. During the decade, the KDPI of US kidneys only increased modestly, while in France, a steadily rising KDPI reflected a trend of more aggressive organ use. Models predicted that many transplanted French kidneys would have had a high probability of discard in the US system. If US centers adopted greater willingness to accept kidneys from older donors and other higher-risk donor groups, this change would provide an additional 132,445 allograft life-years to US transplant candidates over 10 years.

"The global shortage of organs for transplantation is a major public health concern. In the US alone, approximately 100,000 individuals are waiting for a kidney transplant," said Dr. Loupy. "New, creative solutions to address this concern are needed. By comparing transplant practices in two countries, we provide fresh evidence that older deceased donor organs are a valuable underutilized resource."

Dr. Aubert noted that international comparisons of transplant practice offer a natural experiment "so that the successful innovations in each country can be rapidly identified and exported. Transplantation could benefit from additional studies that cross borders, as this one did."